Provider Demographics
NPI:1518615087
Name:SEWELL, KATHLEEN N (LAPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:N
Last Name:SEWELL
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4564
Mailing Address - Country:US
Mailing Address - Phone:404-274-7014
Mailing Address - Fax:
Practice Address - Street 1:2055 SUGARLOAF CIR STE 575
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-9804
Practice Address - Country:US
Practice Address - Phone:404-999-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APC008174101YP2500X
GAAPC008174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional